Basic Information
| Provider Information | |||||||||
| NPI: | 1518279488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALETI | ||||||||
| FirstName: | ANIL | ||||||||
| MiddleName: | R. | ||||||||
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| OtherLastName: | ALETI | ||||||||
| OtherFirstName: | ANIL | ||||||||
| OtherMiddleName: | R. | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 173862 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802173862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033067783 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1906 BLAKE AVE | ||||||||
| Address2: | |||||||||
| City: | GLENWOOD SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816014227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709456535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DR0052689 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01068709 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD440628 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 13559C | WY | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | DR.0052689 | CO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P01217759 | 01 | CO | RAILROAD MEDICARE | OTHER | 47329718 | 05 | CO | MEDICAID | P00982642 | 01 | IN | RAILROAD MEDICARE PTAN | OTHER | 201011500 | 05 | IN | MEDICAID |